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Knowledge, Attitudes and Practices of Young People in Zimbabwe On Mapanga et al. BMC Cancer (2019) 19:845 https://doi.org/10.1186/s12885-019-6060-z RESEARCH ARTICLE Open Access Knowledge, attitudes and practices of young people in Zimbabwe on cervical cancer and HPV, current screening methods and vaccination Witness Mapanga1,2,3* , Brendan Girdler-Brown1 and Elvira Singh1,4,5 Abstract Background: The rise in cervical cancer trends in the past two decades has coincided with the human immunodeficiency virus (HIV) epidemic especially in the sub-Saharan African region. Young people (15 to 24 years old) are associated with many risk factors such as multiple sexual partners, early sexual debut, and high HIV incidences, which increase the chances of developing cervical cancer. The National Cancer Prevention and Control Strategy for Zimbabwe (2014–2018) highlights that no cancer communication strategy focusing on risk factors as primary cancer prevention. Therefore, the study aims to determine the knowledge, attitude and practices of young people in Zimbabwe on cervical cancer, screening, human papillomavirus (HPV) and vaccination. Methods: A cross-sectional survey assessing young people’s knowledge, attitude and practices concerning cervical cancer was conducted in five provinces in Zimbabwe. A total of 751 young people were recruited through a three- stage cluster design from high schools and universities. Knowledge, attitudes and practices were assessed using questions based and adapted from the concepts of the Health Belief Model (HBM) and the Cervical Cancer Measuring tool kit-United Kingdom (UK). Results: Most young people, 87.47% (656/750) claimed to know what the disease called cervical cancer is, with a mean score of 89.98% [95% CI 73.71.11–96.64] between high school and 86.72% [95% CI 83.48–89.40] among university students. There was no significant difference in mean scores between high school and university students (p = 0.676). A risk factor knowledge proficiency score of ≥13 out of 26 was achieved in only 13% of the high school respondents and 14% of the university respondents with a broad range of misconceptions about cervical cancer risk factors in both females and males. There was not much difference on comprehensive knowledge of cervical cancer and its risk factors between female and male students, with the difference in knowledge scores among high school (p = 0.900) and university (p = 0.324) students not statistically significant. In contrast, 43% of respondents heard of cervical cancer screening and prevention, and 47% knew about HPV transmission and prevention. Parents’ educational level, province and smoking, were some of the factors associated with knowledge of and attitude towards cervical among high school and university students. (Continued on next page) * Correspondence: [email protected] 1School of Health Systems and Public Health, Epidemiology & Biostatistics, University of Pretoria, 5-10 H.W. Snyman Building, Pretoria, South Africa 2Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Mapanga et al. BMC Cancer (2019) 19:845 Page 2 of 14 (Continued from previous page) Conclusion: This study revealed that young people in Zimbabwe have an idea about cervical cancer and the seriousness thereof, but they lack adequate knowledge of risk factors. Cervical cancer education and awareness emphasising causes, risk factors and care-seeking behaviours should be commissioned and strengthen at the community, provincial and national level. Developing a standard cervical cancer primary prevention tool that can be integrated into schools can be a step towards addressing health inequity. Keywords: Knowledge, Attitude, Young people, Cervical cancer, Zimbabwe Background their mothers had previously been screened for cervical Engaging in risky sexual behaviour and insufficient cancer [9]. This finding suggests that there is some sort knowledge about health issues remain at alarmingly high of passing down of health knowledge within families es- levels among young people aged between 15 to 24 years pecially when parents have utilised health services. How- old in Africa [1]. This was supported by findings that ever, in a country like Zimbabwe where over 80% of showed that condom use among the 15 to 24-year-olds rural women had no previous knowledge about cervical in sub-Saharan Africa (SSA) was only at 57% for young cancer [10], such passing down of knowledge from par- men and 37% for young women, which was below the ents to children is likely not to exist. Besides, with the 95% target advocated by United Nations General Assem- cultural nature in Zimbabwe, young people’s sexuality is- bly Special Session on HIV and AIDS in 2001 [2]. In sues are rarely discussed openly in families [11], making 2015, 17% of young women aged 15–19 years in it interesting to ask some questions on how much young Zimbabwe reported having had sex with a man 10 years people have learnt from their parents about cervical older than themselves in the past 12 months. Also, HIV cancer. prevalence among young people in Zimbabwe increases On the other hand, recent years have witnessed an in- with age, from around 3% in women aged 15–17 years to crease in risky lifestyle behaviour including early onset 14% among the 23–24-year-olds. Among young men, of sexual activity, multiple sexual partners and age-dis- the HIV prevalence rises from about 2.5% among the parate relationships among the 15 to 24 year age group, 15–17-year-olds to around 6% among the 23–24-year- resulting in high HIV incidence and placing young olds [3]. However, only 64% of young women and 47.5% women at risk [3]. HIV incidence for young women be- of young men have ever been tested for HIV [4]. tween the ages of 15–24 years is reported to be twice Sexual behaviour of both men and women is a risk higher as compared to young men of the same age- factor for cervical cancer. Though they do not develop group in Zimbabwe [4]. Thus the need to understand cervical cancer, assessing knowledge, attitude and prac- the knowledge, attitude and practices of young people tices of young men can be vital if a coordinated inclusive towards cervical cancer. strategy towards prevention of cervical cancer is to be There is scant evidence about young people’s know- formulated as advocated by World Health Organisation ledge and understanding of cervical cancer, risk factors, (WHO) in 2009. Also, involving men in cervical cancer screening and HPV vaccination in the developing world. initiatives such as the human papillomavirus (HPV) vac- Do young people know about cervical cancer? What are cination has a cost-benefit relationship that makes it ne- their beliefs and attitude towards cervical cancer risk cessary for them to be incorporated in cervical cancer factors, screening and HPV vaccination? Do they know prevention strategies [5]. Knowledge and awareness of how and where to access cervical cancer services in the cervical cancer and HPV are consistently low across de- country? Therefore, the study aimed to determine the veloping countries and such lack of knowledge provides knowledge, attitude and practices of young people in a challenge to the implementation of cervical cancer Zimbabwe on cervical cancer, screening, HPV and vac- programmes and the new mass HPV vaccination drive cination so as provide relevant information to cervical [6]. Evidence from a developing country among women cancer stakeholders and programme implementers on aged 18 to 44 years old indicated that the majority of how to attract young people in addressing cervical women are unfamiliar with cervical cancer, HPV, vaccin- cancer. ation and screening and that they face several barriers accessing cervical cancer screening services [7, 8]. Methods Sources of information where people get to know Study design, setting and period about cervical cancer are still limited in developing This cross-sectional study took place in six high schools countries. For example, a study suggested that vacci- and five universities in five provinces in Zimbabwe from nated girls were likely to know about cervical cancer if August to November 2017. The selected sites were Mapanga et al. BMC Cancer (2019) 19:845 Page 3 of 14 located in urban and rural settings in each of the five districts comprised the third stage of sampling. High provinces. schools participants who provided consent were re- cruited for the study through a modified systematic ran- Study population dom sampling of every fifth student. High school class The study population was all young people, 15 to 24 lists were used as sampling frames. There was an auto- years old attending high school or university in matic inclusion in the study for the universities within Zimbabwe. the five selected provinces. If a selected province had more than one university, a random selection of one Sample size determination and sampling method university among the total was carried out (see Add- Power analysis was conducted assuming a power of itional file 1). Purposive sampling was used to select uni- .80 and an alpha of .05. An average response rate of versity participants. This was because it was difficult and 85% was factored-in to adjust for sample sizes. A de- challenging in terms of the logistics to disrupt lectures sign effect of 3 was also factored-in as an adjustment to have all the potential participants in a central place.
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